Alarm over antibiotics

The country's rural population is exposed to serious health hazards, particularly liver and kidney damage, because of indiscriminate taking of antibiotics, a study finds.
A nexus between drug companies and a section of physicians is mainly behind the irrational use of antibiotics. Patients' negligence too is to be blamed, according to the findings.
Citing the study, Kumar Bishwajit Sutradhar, senior lecturer of pharmacy at Stamford University in Dhaka, said drug companies bribe a section of physicians both in cash and kind.
“And the result is prescriptions of inappropriate or unnecessary and expensive drugs.”
Sutradhar and others conducted the study among 6,000 patients and 580 physicians, village doctors and pharmacists in rural areas of Dhaka and Rajshahi divisions from July to December 2012. It was published in the UK-based journal Science Domain International on January 15 this year.
Sutradhar said the findings reflect the situation in the rest of rural Bangladesh and some urban areas as well.
The study found that 44 percent of the doctors prescribe antibiotics for cold, fever and acute respiratory infections without diagnosis, though it is mandatory.  
About negligence on the part of patients, it said almost 50 percent of them stop taking prescribed antibiotics just after the symptoms disappear, while only 25 percent complete dosages. Also, 27 percent believe it is not always important to follow the prescription.
Sutradhar noted that an incomplete antibiotics course means bacteria remains and attacks the human body in the later stages.
Of the patients missing a dose of antibiotic, only 6 percent consult doctors immediately, and 51 percent take the next dose as per schedule, while 23 percent just double the next dose of the drug.
Experts say unnecessary use of these drugs builds antibiotic resistance in human bodies, multiplying the extent of diseases that can even lead to death in extreme cases.
If the resistance continues to develop, bacterial infections could go beyond treatment in future, they add.
“Unnecessary use of antibiotics can damage kidney and liver,” said Dr Mohammed Rahmatullah, pharmacy professor at the University of Development Alternative.
Painkillers like paracetamol and aspirin also affect liver and kidney, but antibiotics do it more. The liver breaks up antibiotics, which then come out of the body system through the kidney.
In this process, if one takes an overdose of antibiotics, liver and kidney damage is the logical consequence, he said.
“If the liver is damaged permanently, its transplantation takes Tk 30-40 lakh. In case of a failure in treatment, the patient faces death.”
A 2008 study by the American Gastroenterological Association Institute identified antibiotics as the single largest class of agents causing idiosyncratic drug-induced liver injury (DILI).
DILI is the most common cause of death from acute liver failure and accounts for approximately 13 percent of cases of acute liver failure in the US.
“Irrational use of antibiotics poses a great danger, as it develops drug resistance faster than what a new generation drug takes to be developed,” said Dr Iqbal Arslan, professor of Biochemistry at Bangabandhu Sheikh Mujib Medical University.  
He blamed it on the counter sales of antibiotics, suggesting the government frame a strict law to prevent sales of antibiotics and painkillers without prescriptions of registered doctors.
Professor ABM Faruque of Dhaka University pharmacy department said according to WHO guidelines, doctors must determine the nature of micro-organisms before prescribing antibiotics. And the medicines prescribed should be low-cost and available and have minimum side effects.
But the guidelines are often ignored, he said.
Contacted, Maj Gen Jahangir Hossain Mollik, director general of Directorate General of Drug Administration, said Bangladesh Medical Association (BMA) could motivate the doctors to be cautious about antibiotics prescription.
On drug companies bribing doctors, he said, “That sort of corruption you will find in all sectors.”
Dr Iqbal Arslan, secretary general of the BMA, said apart from physicians, patients also should be educated so they don't misuse drugs.